Healthcare Form Templates

Browse the healthcare form templates

Need some help getting started with Hush™ Secure Forms? We have a collection of healthcare form templates you can use as a starting point for your form. It’s a great way to find inspiration, or to find a completed template that already works for your business.

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General Healthcare

Request an Appointment (Behavioral Health)

A counseling appointment request form. You can link to this form from your website, social media, and email signature. Your customers can use the form to request an appointment with you.

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Intake Form (Adult)

A general intake form for adult clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Intake form (Child)

A general intake form for child clients. You can send this questionnaire to the parents or guardians of your new clients, to be completed prior to their first appointment.

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Client Experience Survey

A client experience survey. After an appointment, send this survey to your clients to find out what went well, and how they think you can improve.

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Patient Health Questionnaire (PHQ-9)

PHQ-9 is a questionnaire used by qualified professionals to help diagnose, monitor and measure the severity of depression.

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Dental Intake Form

A new dental patient form for your dental practice. You can send this form to your patients prior to their first appointment.

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Request an Appointment (Dental)

A dental appointment request form. You can link to this form from your website, social media, and email signature. Your customers can use the form to request an appointment with you.

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General Anxiety Disorder (GAD-7)

GAD-7 is a questionnaire which can be used by qualified professionals to help diagnose, monitor and measure the severity of anxiety.

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COVID-19 Screening Questionnaire

A COVID-19 screening questionnaire for your clients to complete before their appointment. You can modify the form as needed to comply with local health advice.

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Depression Anxiety Stress Scales (DASS)

The DASS is a 42-item questionnaire designed to help qualified professionals measure the three related negative emotional states of depression, anxiety and tension/stress.

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Depression Anxiety Stress Scales (DASS-21)

The DASS-21 is a 21-item questionnaire designed to help qualified professionals measure the three related negative emotional states of depression, anxiety and tension/stress.

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Massage Therapy Intake Form

An intake form for massage therapy patients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Chiropractic Intake Form

An intake form for chiropractic clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Physical Therapy Intake Form

An intake form for physical therapy clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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PTSD Checklist for DSM-5 (PCL-5)

The PCL-5 is a questionnaire used by qualified professionals to help diagnose, monitor and measure the severity of PTSD. Includes support for the optional LEC-5 and Criterion A formats as well as monthly and weekly formats.

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Alcohol Use Disorders Identification Test (AUDIT)

AUDIT is a questionnaire which can be used by qualified professionals to identify people who would benefit from reducing or ceasing alcohol consumption.

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Therapy Intake Form (Adult)

An intake form for your therapy clients to be completed by adults. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Therapy Intake Form (Child)

An intake form for your therapy clients to be completed for the child. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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